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OBJECTIVE Energy intake, energy density, and nutrient intakes are implicated in type 2 diabetes risk in adults, but little is known about their influence on emerging type 2 diabetes risk [...]

OBJECTIVE--Ethnic differences in type 2 diabetes risk between South Asians and white Europeans originate before adult life and are not fully explained by higher adiposity levels in South Asians. Although [...]

Background: Ischemic heart disease (IHD) rates are lower in UK black Africans and black Caribbeans and higher in South Asians when compared with white Europeans. Ethnic differences in lipid concentrations may play a part in these differences. Objective: The objective was to investigate blood lipid and dietary patterns in UK children from different ethnic groups. Design: This was a cross-sectional study in 2026 UK children (including 285 black Africans, 188 black Caribbeans, 534 South Asians, and 512 white Europeans) attending primary schools in London, Birmingham, and Leicester. We measured fasting blood lipid concentrations and collected 24-h dietary recalls. Results: In comparison with white Europeans, black African children had lower total cholesterol (-0.14 mmol/L; 95% CI: -0.25, -0.04 mmol/L), LDL-cholesterol (-0.10 mmol/L; 95% CI: -0.20, -0.01 mmol/L), and triglyceride concentrations (proportional difference: 0.11 mmol/L; 95% CI: 0.16, -0.06 mmol/L); HDL-cholesterol concentrations were similar. Lower saturated fat intakes (-1.4%: 95% CI: -1.9%, -0.9%) explained the differences between total and LDL cholesterol. Black Caribbean children had total, LDL-cholesterol, HDL-cholesterol, and triglyceride concentrations similar to those for white Europeans, with slightly lower saturated fat intakes. South Asian children had total and LDL-cholesterol concentrations similar to those for white Europeans, lower HDL-cholesterol concentrations (-0.7 mmol/L; 95% CI: 0.11, -0.03 mmol/L), and elevated triglyceride concentrations (proportional difference: 0.14 mmol/L; 95% CI: 0.09, 0.20 mmol/L); higher polyunsaturated and monounsaturated fat intakes did not explain these lipid differences. Conclusions: Only black African children had a blood lipid profile and associated dietary pattern likely to protect against future IHD. The loss of historically lower LDL-cholesterol concentrations among UK black Caribbeans and South Asians may have important adverse consequences for future IHD risk in these groups. Am J Clin Nutr 2010;92:776-83. doi: 10.3945/ajcn.2010.29533.

Background: L-Ascorbic acid is an essential part of the human diet and has been associated with a wide range of chronic complex diseases, including cardiovascular outcomes. To date, there are no confirmed genetic correlates of circulating concentrations of L-ascorbic acid. Objective: We aimed to confirm the existence of an association between common variation at the SLC23A1 gene locus and circulating concentrations of u-ascorbic acid. Design: We used a 2-stage design, which included a discovery cohort (the British Women's Heart and Health Study), a series of follow-up cohorts, and meta-analysis (totaling 15,087 participants) to assess the relation between variation at SLC23A 1 and circulating concentrations of L-ascorbic acid. Results: In the discovery cohort, variation at rs33972313 was associated with a reduction in circulating concentrations of L-ascorbic acid (-4.15 [micro]mol/L; 95% CI: -0.49, -7.81 [micro]mol/L; P = 0.03 reduction per minor allele). Pooled analysis of the relation between rs33972313 and circulating L-ascorbic acid across all studies confirmed this and showed that each additional rare allele was associated with a reduction in circulating concentrations of L-ascorbic acid of -5.98 [micro]mol/L (95% CI: -8.23, -3.73 [micro]mol/L; P = 2.0 x [10.sup.-7] per minor allele). Conclusions: A genetic variant (rs33972313) in the SLC23A1 vitamin C active transporter locus was identified that is reliably associated with circulating concentrations of L-ascorbic acid in the general population. This finding has implications more generally for the epidemiologic investigation of relations between circulating L-ascorbic acid and health outcomes. doi: 10.3945/ajcn.2010.29438.

Background: Earlier studies have suggested that infant feeding may program long-term changes in cholesterol metabolism. Objective: We aimed to examine whether breastfeeding is associated with lower blood cholesterol concentrations in adulthood. Design: The study consisted of a systematic review of published observational studies relating initial infant feeding status to blood cholesterol concentrations in adulthood (ie, aged > 16 y). Data were available from 17 studies (17 498 subjects; 12 890 breastfed, 4608 formula-fed). Mean differences in total cholesterol concentrations (breastfed minus formula-fed) were pooled by using fixed-effect models. Effects of adjustment (for age at outcome, socioeconomic position, body mass index, and smoking status) and exclusion (of nonexclusive breast feeders) were examined. Results: Mean total blood cholesterol was lower (P = 0.037) among those ever breastfed than among those fed formula milk (mean difference: -0.04 mmol/L; 95% CI: -0.08, 0.00 mmol/L). The difference in cholesterol between infant feeding groups was larger (P = 0.005) and more consistent in 7 studies that analyzed 'exclusive' feeding patterns (-0.15 mmol/L; -0.23, -0.06 mmol/L) than in 10 studies that analyzed nonexclusive feeding patterns (-0.01 mmol/L; -0.06, 0.03 mmol/L). Adjustment for potential confounders including socioeconomic position, body mass index, and smoking status in adult life had minimal effect on these estimates. Conclusions: Initial breastfeeding (particularly when exclusive) may be associated with lower blood cholesterol concentrations in later life. Moves to reduce the cholesterol content of formula feeds below those of breast milk should be treated with caution.

Background: An inverse association between birth weight and ischemic heart disease (IHD) has been seen in observational studies. Objective: We wanted to determine the strength and consistency of the association between birth weight and subsequent IHD. Design: We conducted a systematic review of observational studies. Results: Seventeen published studies of birth weight and subsequent IHD were identified that included a total of 144 794 singletons. Relative risk estimates for the association between birth weight and IHD were available from 16 of these studies. Additional data from 2 unpublished studies of 3801 persons were also included. In total, the analyses included data from 18 studies on 4210 nonfatal and 3308 fatal IHD events in 147 009 persons. The mean weighted estimate for the association between birth weight and the combined outcome of nonfatal and fatal IHD was 0.84 (95% CI: 0.81, 0.88) per kilogram of birth weight (P < 0.0001). No significant heterogeneity was observed between estimates in different studies (P = 0.09), nor was there evidence of publication bias (P = 0.3, Begg test). Neither restricting the analysis to fatal IHD events nor adjusting for socioeconomic status had any appreciable effect on the findings. Conclusions: These findings are consistent with a 1 kg higher birth weight being associated with a 10-20% lower risk of subsequent IHD. However, even if causal, interventions to increase birth weight are unlikely to reduce the incidence of IHD materially. Further studies are needed to determine whether the observed association reflects a stronger underlying association with a related exposure or is due (at least in part) to residual confounding. KEY WORDS Birth weight, ischemic heart disease, follow-up studies

Background: Observational evidence suggests that having been breastfed in infancy may reduce the prevalence of type 2 diabetes in later life. Objective: The objective was to examine the influence of initial breastfeeding on type 2 diabetes and blood glucose and insulin concentrations. Design: A systematic review of published studies identified 1010 reports; 23 examined the relation between infant feeding and type 2 diabetes in later life or risk factors for diabetes. Risk factors in infants were examined separately from those in children and adults. All estimates were pooled by using fixed-effect models; differences Results: Subjects who were breastfed had a lower risk of type 2 diabetes in later life than did those who were formula fed (7 studies; 76 744 subjects; odds ratio: 0.61; 95% CI: 0.44, 0.85; P = 0.003). Children and adults without diabetes who had been breastfed had marginally lower fasting insulin concentrations than did those who were formula fed (6 studies; 4800 subjects; percentage difference: -3%; 95% CI: -8%, 1%; P = 0.13); no significant difference in fasting glucose concentrations was observed. Breastfed infants had lower mean preprandial blood glucose (12 studies; 560 subjects; mean difference: -0.17 mmol/L; 95% CI: -0.28, -0.05 mmol/L; P = 0.005) and insulin (7 studies; 291 subjects; mean difference: -2.86 pmol/L; 95% CI: -5.76, 0.04 pmol/L; P = 0.054) concentrations than did those who were formula fed. Conclusion: Breastfeeding in infancy is associated with a reduced risk of type 2 diabetes, with marginally lower insulin concentrations in later life, and with lower blood glucose and serum insulin concentrations in infancy. KEY WORDS Infant feeding, blood glucose, serum insulin, type 2 diabetes, systematic review

Background: Evidence from observational studies has suggested that breastfeeding may reduce the prevalence of obesity in later life. Objective: The objective was to examine whether initial breastfeeding is related to lower mean body mass index (BMI: in kg/[m.sup.2]) throughout life. Design: The study was a systematic review of published studies investigating the association between infant feeding and a measure of obesity or adiposity in later life, which was supplemented with data from unpublished sources. Analyses were based on the mean differences in BMI between those subjects who were initially breastfed and those who were formula-fed (expressed as breastfed minus bottle-fed), which were pooled by using fixed-effects models throughout. Results: From 70 eligible studies, 36 mean differences in BMI (from 355 301 subjects) between those breastfed and those formula-fed (reported as exclusive feeding in 20 studies) were obtained. Breast-feeding was associated with a slightly lower mean BMI than was formula feeding (-0.04; 95% CI: -0.05, -0.02). The mean difference in BMIs appeared larger in 15 small studies of < 1000 subjects (-0.19; 95% CI: -0.31, -0.08) and smaller in larger studies of [micro] 1000 subjects (-0.03; 95% CI: -0.05, -0.02). An Egger test was statistically significant (P = 0.002). Adjustment for socioeconomic status, maternal smoking in pregnancy, and maternal BMI in 11 studies abolished the effect (-0.10: 95% CI: -0.14, -0.06 before adjustment; -0.01: 95% CI: -0.05, 0.03 after adjustment). Conclusions: Mean BMI is lower among breastfed subjects. However, the difference is small and is likely to be strongly influenced by publication bias and confounding factors. Promotion of breastfeeding, although important for other reasons, is not likely to reduce mean BMI. KEY WORDS: Infant feeding, body mass index, systematic review

Abstract Objective To determine whether breast feeding in infancy compared with bottle feeding formula milk is associated with lower mean blood pressure at different ages. Design Systematic review. Data sources [...]

Introduction It has been proposed that events occurring before birth may influence the risk of cardiovascular disease in later life.[1] Associations between small size at birth and increased risk of [...]

Introduction Caffeine is commonly consumed during pregnancy, but elimination from the blood is slowed.' Fetal concentrations are believed to be in equilibrium with maternal concentrations.[1] Although it is biologically plausible [...]

Abstract Objective--To use data from the fourth national survey of morbidity in general practice to investigate the association between home visiting rates and patients' characteristics. Design--Survey of diagnostic data on [...]

Abstract Objective--To examine whether cardiovascular risk factors differ in children from towns in England and Wales with widely differing adult cardiovascular death rates. Design--School based survey conducted during 1994 in [...]

The 1991 census for England and Wales provides substantial amount of data on demography, ethnicity housing tenure, employment status, and other social factors for geographical areas ranging in size from [...]

Objectives--To produce practice and patient variables for general practices from census and family health services authority data, and to determine the importance of these variables in explaining variation in cervical [...]

Abstract Objective--To assess effect of unemployment and early retirement on mortality in a group of middle aged British men. Design--Prospective cohort study (British Regional Heart Study). Five years after initial [...]

Abstract Objective--To examine the importance of parental smoking on passive exposure to tobacco smoke in children and the social and geographical patterns of exposure. Design--Cross sectional study. Setting--Schools in 10 [...]

Introduction Many cross sectional studies have found that unemployed men are more likely to smoke cigarettes and to consume more alcohol than employed men.[1-10] There are two possible explanations for [...]

Abstract Objective To determine whether children's exposure to passive smoking has changed since the late 1980s. Design Cross sectional surveys of nationally representative samples of secondary school children carried out [...]

Hormone replacement therapy is widely promoted to prevent cardiovascular disease and osteoporosis and relieve menopausal symptoms, although concern exists that much of the cardiovascular effect may be due to its [...]

Measures of the social, ethnic, and demographic characteristics of general practice populations are essential both for planning health services and for research. Such measures can be derived by combining census [...]